Fit for All Personal Training

Runners high

tammy.curtis@fitforall.net.au — Sun, 25 Apr 2021 17:24:57 +0000

It’s now almost 8 months since surgery and I’m finally pleased to say that I have taken some positive steps towards healing. In fact just this week I did my second run on a treadmill. When I say “run” I mean more like a Cliff Young shuffle at 7kmph, but hey in my book that is a run! It was also only for 30 seconds (30s run, 30s walk x 10), but that’s 30 seconds more than I have done in 8 months. Now I’m trying to not get too excited as I still have a long way to go. But today on that treadmill for a brief moment I experienced a runners’ high, a brief sense of euphoria, I felt invincible! The feeling of running again, a movement I haven’t been able to do since January, was fantastic. I can’t wait to do it again later this week.

Over the past few months I’ve had a chance to reflect on this whole journey. A bit like pregnancy (so people tell me), there are many things that you aren’t told about what to expect in recovering from such an invasive procedure. Here is my list of top 10 things I have learnt from having knee surgery:

Ask more questions

The brief consultations with the surgeon pre and post-surgery are a window of opportunities to ask questions. Write them down so that you remember and note any answers.

Rehab takes longer than you think

Everyone who undergoes surgical procedures will have a different length of recovery. It really depends on the extent and trauma associated with the surgery. There is no set time frame.

Be patient

It can be so easy to give up when progress is very slow. With each rehab session comes a step closer to getting better. Just keep going!

Enjoy progress

When rehabbing daily you become very in-tune with your body and tend to notice any little changes or progress. These milestones bring such joy and excitement, even when they are small.

Set goals

It’s important to set goals to tick off along the way. My goal originally to be back running a short distance pain-free was 6 months, but now it seems more realistic for it to be 12 months. It will happen.

Buy shares in a physiotherapy business

No one really warns you of the expenses post-surgery. Between fortnightly physiotherapy, myotherapy, gym and pool sessions over the last 8 months I cringe at the cost calculation.

Get on a Medical Care Plan

If you have had recent surgery then you are eligible through your GP for a Medical Care Plan. This entitles you to 5 half price physiotherapy sessions which makes a huge difference!

It’s all about the un-sexy exercises

I am the one in the gym doing all the not-so-glamorous exercises like lying on the ground with a ball between my legs and butt in the air like I’m giving birth to a medicine ball. Not attractive but effective.

Don’t forget about the other knee

When the recovering knee receives all the attention it is easy to forget about the good knee. As rehab progresses remember to do the same exercises on both sides of the body.

I’m a cyclist, not a runner

Years of knee pain and this recovery journey has made me re-assess how to get the best out of my body going forward. Cycling reduces the impact through my knee and over the last 7+ years has become my passion with running taking a firm back-seat. That’s just how it has to be now.

Listen to your body

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:24:37 +0000

Surgery number three, done and dusted.

Having the experience of multiple knee surgeries definitely puts me in a good place to know and understand my body more in its repair process. Although all three procedures have been different somewhat, the rebuild is very similar.

Our body is a very clever natural biofeedback system. It is continuously giving us signs and telling us what it does and doesn’t need. During this rehab process it is hugely important that we listen carefully to these signs in order to work our way back to full functionality. Signs that we are overdoing it or not doing enough can be loud and clear if we pay attention.

How do I know I’m doing too much?

Following a structured program of activating, stretching and strengthening is a must for a successful and speedy recovery and should be set by a physiotherapist generally commencing the day after surgery. But for some of us who are in a rush to return to our daily activities, jobs and sports – we can get caught out doing too much too soon. The biofeedback our body gives that we might be crossing that line can be:

Inflammation tends to be a visual sign where additional swelling, heat and redness may be present
Pain in the form of achiness or throbbing beyond the expected range
Sleepless nights that usually arise from discomfort or lack of blood flow
Decreased function by not showing improvement throughout the rehab phase
Increase in pain medication to mitigate additional pain

How do I know I’m not doing enough?

On the opposite side of the coin, sometimes we are not doing enough and therefore slowing down our return to full functionality and may require additional physiotherapy which tends to be costly. These signs can be:

Severe muscle atrophy where muscles surrounding the injured area significantly deteriorate
Major loss of strength and control in surrounding muscles
Incorrect gait or posture as a result of compensation when strength hasn’t been regained
Slow return to activities if the work hasn’t been done to safely recommence those movements

How to find the balance

Ideally, we need to find a balance between the two extremes for the fastest recovery. There is no set plan that works perfectly for every body and people do tend to recover at varying rates. My recommendation is to employ a well credentialled physiotherapist so that your rehab can be tailored to your needs. But beyond that, here are some simple things that I am using and you can do for yourself:

Track your rehab using a simple diary where you can document all of your activities noting the date, activity type, duration, intensity and any comments on how you’re feeling. This allows you to track the small progressions of your recovery and to identify if you may have done too much or need to do more. This is also a very handy document to take to each physiotherapy session as they will also be able to extract information from it and align appropriate treatments
Use photos to compare the injured site. This can show building of muscle and also inflammation. Having this information is excellent feedback for adjustments
Check with your physiotherapist/surgeon/doctor if you’re unsure or have any questions. They are medically qualified to deal with rehabilitation and can provide you with advice for your situation
Drink water and eat lighter particularly in the early stages of recovery, you won’t be moving as much as you usually do and therefore burning less calories. Adding extra body weight throughout this period is very easy to do but will only make your recovery a little harder. Water helps the body get rid of toxins from anaesthesia
Use Rest, Ice, Compression and Elevation whenever possible. This will give the area time to heal without putting stress through the body. This is just as important as the exercise part!

My current rehab diary

Just remember, everyone’s journey is different in recovery and often we have set backs. By using these tips hopefully those set backs are identifiable and your rehab can be modified to suit you getting back to 100%. Onwards and upwards!

Third time lucky

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:24:09 +0000

It has now been 2 years and 2 months (not that I’m counting!) since my partial knee replacement and it’s still bothering me. The knee joint itself feels pretty good, the part that bothers me is the area around the top and to the outside of my patella. All of my experimental methods of cupping, wedging, dry needling, massage…the list goes on, has not quite hit the spot. I even gave some low-level laser treatment a try for three weeks to see if that could have any impact, but sadly it didn’t help.

So, my next port of call was to see a Sports Physician to see if they had any different ideas. I had a telehealth call (the new world of Covid-19 that we are living in) with a Doctor from Melbourne Olympic Park Sports Medicine who has seen a lot of knee injuries from working with the Australian Netball team. She had some really good information about some other options, but wanted to also get input from my physio and surgeon. So off I went last week to sit in the dreaded surgeon’s waiting room again with fresh x-rays and ultrasounds in hand.

I had mixed feelings about seeing my surgeon again. He was either going to a) sharpen his scalpel as he sees me walk in, or b) tell me this is as good as it’s going to get so you need to learn to live with it. Both involves pain.

Given this orthopaedic surgeon specialises in hips and knees I was convinced that he would have seen plenty of people like me before and that he would have the answer for me. After the small talk was done it took him just 5mins to identify the cause of my pain. Why didn’t I come and see him earlier?

With the resetting of my patella into the correct groove during my last surgery, it now tracks in its correct alignment however one of my quadriceps tendons is now exposed and is causing friction against the femur bone creating pain and scar tissue. Bingo!

So my surgeon is now sharpening his scalpel for my next visit which will be minor surgery to clean that particular space around my patella. In fact, he said it would be so minor that I would be walking out of the hospital the same day as the procedure and I won’t miss a day of work. Sounds simple, let’s hope he’s right and that it’s third time lucky for me.

It’s time to race

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:23:31 +0000

Over the last 19 months since my knee surgery, spending time on my bike has not only helped strengthen my legs but also provided a lot of sanity and a good measure of my progress. I have ridden over 8,500km on my bike since surgery (yes, I’m that nerd who keeps track of things like this).

I wasn’t really surprised that I grooved my way into a saddle since I’ve always enjoyed riding from a youngster as it was our mode of transport to and from primary school (7km round trip). So for cycling to be a big part of my rehab post-surgery fitted me well.

About a month ago I decided to take my bike riding to the next level and try my hand at racing to get my competitive juices flowing again and test myself against other girls. I have missed being involved in sport competitively with my knee only allowing me to play one season of women’s footy and one half marathon over the last ten years; and I could only get so competitive with myself in the gym and social rides on the bike.

I had my hesitations about competitive riding initially, as crashing and damaging my knee was in the back of my mind and there is no way I want to go through this whole recovery process again.

Nervously I approached the start line in C grade of my very first criterium race. The racing official told us that we have 30mins of racing then the bell would ring and we had just one lap of the 1km circuit to race to the line.

So off we went riding the circuit taking our turn on the front each lap to share the load. It was such a buzz. I could feel the adrenaline pumping throughout my body and even when my heart rate was through the roof you could not wipe the big smile off my face. It was fantastic, I loved every minute of it. As the 30mins approached and I heard the bell ring I knew this was when the real race happens and the intensity was going to lift to another level. Unfortunately my inexperience in racing showed and in my eagerness to race to the line I sprinted way too early only to have two other girls behind me race past when my legs had nothing left before the line.

I crossed the line and immediately wondered why on earth did I wait this long to try racing? I loved it and couldn’t wait for the next race. As it turned out, the two girls who passed me before the finish line were from B grade which made me the first C grader. Winner! After that win, I have been promoted to B grade. Now with two seconds and a third in the last few weeks I’m eagerly eyeing that top step. With that goal in mind…what knee pain?

That pesky last 10%

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:22:38 +0000

I’m almost there…

15 months have now come and gone in my recovery journey of my partial knee replacement. It seems like a lifetime ago my surgeon was sharpening his scalpels with a crazy grin on his face.

Since my last update, I have taken leaps and bounds in my recovery as I continue to build strength, range of motion, and correct my biomechanics. It’s difficult to pin-point exactly what is helping the most but I suspect it’s a combination of treatment, daily exercises and good old fashioned ‘time’. In my quest for getting back to a full recovery I have been experimenting with three methods to accelerate the process:

Strength Training

Without question, strength training is an essential part of recovery. However the usual strength training protocol for exercises in rehabilitation is often prescribed as light resistance and lots of repetitions (ie. 2-3 sets of 15+ reps). Upon visiting a knee specialist physiotherapist late last year, the latest research seems to have flipped that theory on its head and now studies are revealing greater improvements for heavy weights (as heavy as you can with-stand) to be lifted and less repetitions (ie. 4-5 sets of 8 reps) causing a greater strength response from the deteriorated muscles. Obviously this method should only kick in when healing around the joint has occurred and it must be completed in a pain free range. Incredibly once I implemented this protocol my leg strength rapidly increased and my quadriceps muscles began to appear again. This had huge implications on my cycling as I felt power quickly return. Happy days!

Wedging

My physiotherapist is one of the best in her field as she not only has experience working with elite tennis athletes (Serena Williams, Lindsay Davenport, Kim Clijsters to name-drop a few) but also one who continues to learn and try new techniques. One of those new techniques she recently added to her bag of tricks was ‘wedging’. Not the kind that makes your undies almost disappear, but one that involves placing small wedges under foot to retrain correct foot mechanics throughout phases of your gait. Seemed unusual at first but after daily practice I noticed that I began walking much freer and less compensating for my operated knee. Normal walking – tick!

Cupping

The last and most recent method I’ve employed is cupping. The pain I still feel comes from the lengthy scar from the operation where tissue of muscle and fascia were cut to give access to the inside of the knee. After a little research I decided to give cupping a go to help break up adhesions within the scar. After just three sessions I have gained further pain free range in my squats and lunges. This I’m VERY happy to report.

With these new methods implemented, just last week I completed my first 4km run outside. I can’t tell you how amazing this felt as this was an activity I really wasn’t sure I’d ever be able to do again pain free. Being able to run without the all too familiar discomfort in my knee along my local bike path was an AMAZING feeling and something I will never take for granted. Now to just get through this last 10% in my recovery and this whole journey will be SO worth it.

The physical and mental game

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:21:59 +0000

It’s been quite a while since I have added to my blog, and there are a few reasons for this. It is now just over 12 months since my second surgery and there have been many physical and mental battles to overcome in the process. I guess it took more of a toll on me than I thought it would. The daily reminder of pain in certain movements and a nasty scar bearing up at me makes it difficult to not think about all of the time.

If you had have asked me over the last 6-8 months how my knee was going, you probably would have received a rather negative answer from me. This was a reflection of my mental frustration from the slow process of rehabilitation. It’s so bloody slow! As diligent as I am with my exercises, stretches, foam rolling, massages and treatments, I just can’t speed up the process. However there has never been a single day where I wanted to give up and throw the towel in.

“You and only you have the power to choose how to respond to the challenges in front of you” – Dan Green

Every day I’m in search of answers to find that little extra edge of improvement. I’ve spent many hours reading, researching, and chatting with health practitioners to see if I’m missing something. Let’s just say I’m quickly becoming a knee rehabilitation specialist Personal Trainer.

Physically I’m now doing much better. I achieved a few goals I set in my previous blog; completed cycling holiday from Amsterdam to Bruges, have ridden over 100Km several times, rode Mt Donna Buang (16.8km hill), can do a standing quad stretch and get heel to butt with ease, and banked many thousands of calf raises (they should be HUGE by now but sadly they’re not).

But over the last 8 weeks something has changed and I’ve really noticed specifically big steps in my improvement. A combination of some new physiotherapy treatment methods, a visit to a knee physiotherapy specialist, change in my strength program, have all added to reducing painful movements and seeing more leg muscle tone return. I’m now riding my bike faster and stronger than I was before both surgeries, and I have gradually commenced treadmill running for 15mins twice per week. Both of these activities give me great pleasure in being able to do so I’ll be aiming to improve further over the next 12 months. I certainly don’t plan on running a marathon, just a steady 5km pain-free would make me extremely happy. My next immediate goals are getting back to squatting and lunging pain-free in full range. I can sense it is getting nearer day by day.

Along with these physical changes I have noticed also a mental shift. The negativity has lifted and I’m speaking more optimistic about my recovery. My mind and body are both healing, great signs.

I can’t thank the people around me enough for what they have done for keeping positive and promising it will get better. They’re right, just sometimes I can’t see through the rehab fog and spot the finish line. But I’m getting there now. My partner, friends, family, clients and my bike riding buddies are all part of my incredible support network.

My scar is still quite prominent and has attracted a few questions from strangers who are curious of how it came about. Sadly I don’t have some heroic story to give them, just a worn-out knee that needed partial replacement. To which they then give me their best pain-face followed by their own knee injury story. I’m thankful for their compassion and enjoy asking them questions about their recovery hoping to pick up some tips to help me on my journey. Once my scar has faded more I have decided to feature it in a tattoo, stay tuned for that one.

In the meantime, I’ve got more work ahead of me. With a positive mindset I’ll be jumping these last few hurdles (literally!).

The long hard road to recovery

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:21:25 +0000

I’m almost 8 weeks post-surgery now and I feel like most of the pain and frustration is over, I think. I had a follow-up appointment with my surgeon at the 4 week mark and he gave the green light to step up my rehab and push through my discomfort further. In other words “harden up”! That was quite a blow to my ego as I thought I had a fairly high pain tolerance. Then as a test he forced my knee to bend back towards my chest and held it there for a count of ten. Quite possibly the most painful 10 seconds I’ve ever experienced as I felt little tears run down my face. His response was “See, you didn’t yell the roof down. You need to do this to yourself every day and get this knee moving”. I guess it was some tough love and the start of a couple of months of daily pain I need to work through. Never ask a surgeon for some compassion! The good part of seeing the surgeon was that he was very satisfied with his handy work and convinced me that I’ll be up and running with a brand new knee once it has all healed. Sweet!

I have just finished a block of bi-weekly visits to my amazing physio and now down to just weekly. These sessions have been far from ‘fun’ as the primary goal has been to get full movement back into my knee. If you live in Ashburton you may have heard my cries of pain! I still have some internal muscle and bone bruising from the operation which restricts full flexion of my knee, and this is where physiotherapy is necessary to get back to full function and also break up scar tissue. In fact, before each session I take pain killers to be able to get through it. I put the pain all in perspective when I look at my x-ray and see what trauma my knee went through. Bone drilling into my femur and screws in my patella are the more obvious ones, not to mention cut nerves and tendons.

The recovery process has certainly taken its toll on me both mentally and physically, mostly due to lack of sleep. Only now have I started sleeping through the whole night without being woken up by my aching knee. Perhaps now I have some idea of what a new Mum might feel!

Rehab exercises consist of a lot of water running, stretching, foam rolling, and muscle activations. Gradually I can see my quads and calves returning as I’m able to stimulate them with the many exercises prescribed from my physio.

Day to day is about setting small goals to stay focused on my rehab. Ticking the boxes of these little landmarks gives me a sense of achievement and that I’m heading in the right direction. So far I have succeeded in: ditching the crutches, driving my car, returning to work, riding a spin bike, walking without a limp, improving my degree of flexion at each physio session, doing some body weight squats, and having a whole night of uninterrupted sleep (finally)! I managed to tick off one of my biggest goals on the weekend when I finally got to ride my bike back on the road again and cruise along with my bike buddies. This was my most satisfying accomplishment so far and has given me a big boost in confidence.

My next goals are to: be able to grab my leg to do a standing quad stretch, do a lunge, a single leg calf raise in full, some weighted squats, ride some hills, reach 100km in a single ride, and complete my cycling holiday from Amsterdam to Bruges in July. So I still have a lot of work to do. Then after those goals are checked, it will be time to run again. Something I haven’t been able to do properly now for 16 months. That will be the big test to measure the success of this journey. Bring it on.

It’s D-Day

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:20:47 +0000

In the leading days to my surgery I put in some very long days in the studio in preparation for 19 days off. Thankfully I have some wonderfully understanding clients who may actually be relieved to not see me for a while after a few tough sessions. At this point I have done all that I can to keep my legs strong and sizeable in preparation to have them disappear in just days. Mentally and physically I was ready, just don’t get me started about coverage of private health insurance!
I was admitted to hospital for three nights of which I initially questioned. Only to find out that it was due to pain management and reduction of possible infection. It was at this point I realised this operation was next level compared to last one. Be prepared for some pain.

My hospital experience was memorable to say the least. The joys of having such intrusive surgery meant that I got to have a spinal anaesthesia numbing everything from the waist down. So quicker than I could blink an eye it was all over and I was placed in recovery. At this point feeling rather drunk on strong pain killers I was lulled into a moment of “well that was easy”. I was wheeled back to my hospital bed where my roommate applauded my return, a lovely lady from the country who had a similar procedure to me the day before. With tubes and drip lines having been inserted whilst under anaesthetic, I quickly realised that I had a catheter. Not having had one of these before I was intrigued. A few hours later a nurse visited to check my vitals and asked if I was comfortable. Under the medicated influence I mentioned that my thigh felt a bit sweaty. Only then did we realise that the catheter had disconnected and that I had fundamentally wet the bed. I was mortified! Huge credit goes to the nurse though who magically changed the fitted sheet with me still in bed. Amazing skills!

After a tough night of broken sleep, the next day my surgeon visited and said the operation was a success and that my knee should be as good as new. Let’s hope so! I had the catheter fully removed and it was time to test getting out of bed to use the toilet and have a much needed shower. Using the walking frame I managed to achieve both but the pain was now starting to intensify. Showering wasn’t such an issue but the toilet offered a whole new challenge. Without being able to bend my right knee I could only awkwardly sit on a raised toilet seat frame but needed to lean back slightly. Given there was a gap between the frame and actual toilet seat as I relieved myself I suddenly felt my foot getting wet. Are you serious? I can’t even aim into the bowl! As I climbed off the seat and exited the bathroom red faced I mentioned quietly to the nurse what had happened only to hear my roommate yell out “ah don’t worry about it love, once the catheter is taken out you’re all crooked anyway, no chance of aiming straight”.

I’m ten days post-surgery now, and my recovery is going much slower than I anticipated. I’ve experienced the highs and lows of getting through the early stages off heavy pain killers and am making quite a body dent into the couch as I watch trashy tv and doze in and out. Plenty of cuddles from our cat is definitely helping as is lots of messages and visitors. Tomorrow I get to remove the dressing and get first look at my big scar. Looking forward to seeing how it is healing. Until then I’ll nibble the ears off my Lindt bunny and get back to watching some episodes of Survivor. Happy Easter.

Here we go again…

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:19:52 +0000

As it turns out, I am 12 days from it being a year since my lateral release surgery and sadly my knee functionality is certainly not where I expected it to be. After a long slog of rehabilitation and physiotherapy, ups and downs, it still hurts. An MRI a few weeks ago confirmed my cartilage under my patella is wearing poorly and a couple of cysts have popped up from the friction. This explains the pain I’ve been feeling and why it has stopped me in my tracks of recovery. Not ideal shall we say.

A visit to my surgeon confirmed what I suspected after having the MRI results read, and it’s back for more surgery! This time he is taking a less conservative approach and going to resurface the back of my patella putting in a synthetic material in place of my cartilage. This is to reduce friction and smooth the surface so that the femur (thigh bone) and patella can articulate correctly. This means a longer hospital stay, more pain killers and a lovely big scar down the outside of my leg. There goes my leg modelling ambitions.

So in two months’ time I’ll be back to square one and beginning the rehabilitation process all over again. At least this time I’ll be familiar with the exercises and glad I didn’t give my crutches to the Salvo’s.

In the mean time I will continue to strengthen my legs with movements that only give low level pain or none at all so that I don’t lose all of the muscle I have gained. I’ll continue cycling but try to avoid too many long hills when my knee pain kicks in. Aside from that I plan on enjoying the rest of summer and know that I have a long road ahead of me this year. Still determined as ever to be pain free!!!

Is it time to run yet?

tammy.curtis@fitforall.net.au — Mon, 26 Apr 2021 03:18:59 +0000

The million dollar question – can I run yet? I’m now four months post-surgery where I was told by my surgeon I should be fine to start back running. The reality is I’m nowhere near ready to run. It’s looking more likely to be 6 months post-surgery before I start light running but it could be anywhere up to 12 months for full recovery. Sadly I still can’t put load through any lunges, step downs or single leg squats and have only just started to squat lightly with only low level pain. Scar tissue is still breaking down and my patella tendon is a little angry when I try to load it.

It’s not all doom and gloom though, I’m continuing to make progress in my strength, flexibility, balance, and retraining my nervous system to recruit better motor patterns for which I have been compensating for so many years carrying this knee pain. I’m back doing spin classes and riding my road bike often. I’m now handling 100km rides well which makes me happy, but I’m not ready for any lengthy hills just yet. So I guess you could say I am progressing. Despite all of the daily rehabilitation work I have been doing, weekly physiotherapy or myotherapy treatments, bike riding and swimming; it still feels like the progress is going at snails-pace.

I can see how people would just give up right about now with their rehabilitation plan. Not only is it very costly with all of the weekly treatments, but mentally it can be disheartening. So I like to keep the bigger picture in mind and imagine running pain-free eventually. Each day I find myself searching for any little sign of improvement and can go through a seesaw of emotions as I complete my rehab exercises. But one thing is for sure – I will not give up!

Just this week a Facebook memory from four years ago popped up in my news feed. It was photos of me crossing the line in the Great Ocean Road half marathon (whilst carrying my chronic knee pain – I’ll do anything to achieve my goals!) and some nasty blisters on my toes from a very poor choice of socks! It was just what I needed to keep my motivation high and focus on my end goal of possibly another half marathon (most likely just 10km and I’ll be happy) but this time without the pain.